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Patient-Tailored Decision Support System Improves Short- and Long-Term Glycemic Control in Type 2 Diabetes.

Authors
  • Augstein, Petra1, 2
  • Heinke, Peter1
  • Vogt, Lutz3
  • Kohnert, Klaus-Dieter1
  • Salzsieder, Eckhard1
  • 1 Institute of Diabetes "Gerhardt Katsch", Karlsburg, Germany. , (Germany)
  • 2 Department for Diabetology, Klinikum Karlsburg, Heart and Diabetes Center Karlsburg, Germany. , (Germany)
  • 3 Diabetes Service Centre DCC, Karlsburg, Germany. , (Germany)
Type
Published Article
Journal
Journal of Diabetes Science and Technology
Publisher
SAGE Publications
Publication Date
Sep 01, 2022
Volume
16
Issue
5
Pages
1159–1166
Identifiers
DOI: 10.1177/19322968211008871
PMID: 34000840
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The increasing prevalence of type 2 diabetes mellitus (T2D) and specialist shortage has caused a healthcare gap that can be bridged by a decision support system (DSS). We investigated whether a diabetes DSS can improve long- and/or short-term glycemic control. This is a retrospective observational cohort study of the Diabetiva program, which offered a patient-tailored DSS using Karlsburger Diabetes-Management System (KADIS) once a year. Glycemic control was analyzed at baseline and after 12 months in 452 individuals with T2D. Time in range (TIR; glucose 3.9-10 mmol/L) and Q-Score, a composite metric developed for analysis of continuous glucose profiles, were short-term and HbA1c long-term measures of glycemic control. Glucose variability (GV) was also measured. At baseline, one-third of patients had good short- and long-term glycemic control. Q-Score identified insufficient short-term glycemic control in 17.9% of patients with HbA1c <6.5%, mainly due to hypoglycemia. GV and hyperglycemia were responsible in patients with HbA1c >7.5% and >8%, respectively. Application of DSS at baseline improved short- and long-term glycemic control, as shown by the reduced Q-Score, GV, and HbA1c after 12 months. Multiple regression demonstrated that the total effect on GV resulted from the single effects of all influential parameters. DSS can improve short- and long-term glycemic control in individuals with T2D without increasing hypoglycemia. The Q-Score allows identification of individuals with insufficient glycemic control. An effective strategy for therapy optimization could be the selection of individuals with T2D most at need using the Q-Score, followed by offering patient-tailored DSS.

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